Advances in Treating Iron-Deficiency Anemia
Iron is crucial for helping our bodies function well. Without enough iron, you won’t have enough red blood cells which carry oxygen throughout your body, which means your tissues and organs won’t receive the oxygen they need to do their jobs. When this happens, it’s called iron-deficiency anemia, a condition that can cause symptoms like lightheadedness, shortness of breath, fatigue, and more. If untreated, iron-deficiency anemia can lead to serious consequences, including severe organ damage. Fortunately, iron-deficiency anemia can be treated successfully: patients need to simply take in supplemental iron to replace the iron they’re lacking. There are two main ways to do this, and treatment advances in the last decade have made them safer and more effective.
Iron-deficiency anemia has a few causes. Patients might be low in iron because they’ve lost a lot of blood, which can be due to heavy menstrual cycles or diseases that cause bleeding in the stomach lining or intestines. It’s also possible some patients don’t get enough iron from their diet; we see this especially in vegetarians and vegans, as they avoid iron-rich meat. Patients may also have low iron levels because their bodies can’t absorb iron properly from food they eat, due to celiac disease or weight loss surgery.
There are two methods for replacing iron; patients can take oral iron tablets every day or receive intravenous (IV) iron about once a week. Most patients with iron-deficiency anemia are prescribed oral iron tablets to take daily for 8 to 12 weeks. Usually, I ask people to take 325 mg of iron at least twice a day, preferably three times daily. However, having taken oral iron myself, I know that’s a big thing to ask, because oral iron can cause a lot of GI-related side effects. It causes gas retention and irritation in the GI tract, and people may have feelings of indigestion. Oral iron also slows down movement in the intestines, which can lead to severe constipation. To avoid this, I’ll often recommend taking a stool softener along with the iron tablet.
About half my patients can’t take oral iron. In many cases, the GI side effects are too much for them to tolerate, especially if they have inflammatory bowel diseases like ulcerative colitis or Crohn’s disease. Some patients won’t benefit from oral iron if they are unable to absorb iron through the stomach due to gastric bypass or celiac disease. In these cases, we turn to IV iron. Patients must come to an infusion clinic once a week, and the iron is administered over a very short period of time, somewhere between 15 and 30 minutes. Today, patients usually don’t have any type of reaction to the infusion, and they avoid GI side effects because we bypass the GI tract altogether. Typically, IV iron corrects anemia in about a third of the time it takes to replace iron orally. Instead of months on oral iron therapy, most IV iron patients can finish the iron replacement process in a few weeks.
Receiving IV iron used to be a riskier procedure, but recent advances have improved the process immensely. In the past, IV iron preparations often caused serious allergic reactions. These were so common and so severe that 10 or 15 years ago, we almost always hospitalized patients while they received IV iron. There was also the need to medicate patients in advance to prevent these reactions, which meant they were sedated and couldn’t drive themselves to and from infusions. Because of these challenges, we really pushed patients to stick with the oral iron despite the difficult side effects; we didn’t want to try IV iron unless absolutely necessary. Now, with the newer IV iron preparations, the risk of allergic reaction is incredibly low. Patients can drive themselves to the infusion clinic, receive their IV iron, and drive away less than an hour later.
Watching these improvements over the last decade of my career has been really exciting. Now that IV iron is safer and more effective, it’s been a game changer for patients who couldn’t take oral iron. This is why it’s so important to have an honest and trusting partnership with your doctor; if you’re having trouble with oral iron supplements, don’t hesitate to talk to your doctor about another option.